| NPI | 1205000619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN DANIEL SWEEN Owner 763-757-3430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MN 10941) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2008-04-16 |